HRAUN/iStockBY: BENJAMIN SIEGEL AND JOSH MARGOLIN, ABC NEWS
(NEW YORK) — Dr. Sandra Fryhofer had so much trouble finding surgical gowns and masks for her Atlanta office several weeks ago that she said she was forced to rely on her patients for help.
"One of my patients had a friend who lives in China, so early on, she sent me 30 masks," Fryhofer told ABC News. "When I got them, I just cried because there was a time that I didn’t have anything to offer my staff."
Now in July, as coronavirus cases rise in Georgia and 38 other states and some set hospitalization records, Fryhofer said she's still struggling to provide protective equipment for her staff -- and she's not alone. Front-line medical workers and doctors in private practice are again sounding the alarm over ongoing shortages of protective gear, as they are forced to burn through supplies to treat the growing number of infected patients.
Months after some New York City nurses were forced to wear garbage bags for protection, the shortage of protective gear impacting rural and urban hospitals, nursing homes and private physicians' offices is one of several problems with the nation's pandemic response that have resurfaced again, along with delays in testing and crowded hospitals in several regions.
“I just cannot believe that we are in this situation again,” said Dr. Leana Wen, an emergency physician and public health professor at George Washington University, who previously served as Baltimore's Health Commissioner. “It’s because of failure of planning and anticipation.”
In interviews with ABC News, nurses, doctors and health care supply chain experts blamed the scarcity of masks, gowns and gloves on the Trump administration’s decision not to centralize and coordinate the purchase of protective gear, which has forced states and hospitals to bid against each other.
“Everybody thought it was kind of solved, but it really hasn't been,” Deborah Burger, the president of National Nurses United, told ABC News.
They also expressed frustration with the lack of transparency with the state of the supply chain, and President Trump’s refusal to leverage the Defense Production Act to compel producers to scale up operations to prepare for the resurgence of the virus.
In response to ABC News' questions, a spokesperson for the Federal Emergency Management Agency, which leads the federal government's supply efforts, said it is working with states and partners to obtain more protective gear, and pointed to the prior delivery of tens of millions of pieces of personal protective equipment, known as PPE, to the nation's health care facilities.
But despite the delivery of protective equipment to the states, an internal administration document obtained by ABC News suggests that the federal government has yet to meet the demand for millions more of pieces of gear.
The internal administration briefing prepared for senior leadership of FEMA and Department of Health and Human Services on July 10 noted that the administration had only supplied 29% of surgical gowns, 30% of gloves and 4% of boot coverings requested by states and territories.
The document also stated that the administration had delivered roughly 40% of the nearly 176,000 body bags requested by the states and territories. FEMA declined to comment on the document.
Survey: Most nurses re-using "single-use" masks
In June, NNU, the nation’s largest nursing union, released a survey of 23,000 nurses that found 87% of respondents were forced to reuse single-use disposable N95 masks with COVID patients.
Burger, who also works in California’s Sonoma County, said the limited supply of masks on the market has led hospitals to ration the gear distributed to staff, forcing many to reuse old masks and gowns longer than recommended.
“In a country that's this rich with resources, it seems criminal that nurses, and health care workers are having to make do with garbage bags and other cobbled together, non-certified, safe equipment,” Burger told ABC News.
Guy Sneed, the division chief medical officer for Hillcrest Healthcare System in Oklahoma, told ABC News that his system has been reprocessing N95 masks since April, which will allow some masks to be used as many as 10 times if needed.
Dr. Michael Seemuller, the Chair of Quality and Safety for AnMed Health Physician Network in South Carolina, told ABC News that it's "impossible to predict how long our PPE will last."
"We are running out of medically-fit N-95 masks that are the most snug, so we have to rely on N-95 masks that may not always fit the wearer," Seemuller told ABC News.
The supply problem can extend well beyond large, well-known hospitals and into private practices that dot the nation and serve millions of Americans, according to Dr. Susan Bailey, a Fort-Worth based immunologist and president of the American Medical Association.
“Most physicians’ practices didn't use PPE at all before the pandemic or just to a very limited extent,” she said. “They have no supply chain. They have no regular supplier. There are doctors going to Amazon, to try, to find, to buy masks.”
Pleas for help, and transparency, from the government
At the end of last month -- nearly four months after the first coronavirus case was reported in the U.S. -- the AMA asked the Federal Emergency Management Agency to be more transparent about the protective gear supply chain and where the problems still exist.
“A significant obstacle to crafting effective solutions has been the lack of data to help us ascertain whether the central problem is in the availability of raw material, production backlogs, gaps in the distribution systems, or some combination of all three,” the group recently wrote to FEMA Administrator Peter Gaynor.
The organization also wrote to Vice President Mike Pence, requesting the administration leverage the Defense Production Act to ramp up production of both N95 masks and gowns.
The administration has repeatedly invoked the act to spur the production of ventilators and testing supplies -- and also used it in April to order more than 160 million N95 masks from 3M. But critics and experts said the Trump administration could leverage its authorities under the act more aggressively to address the protective gear shortages.
While Congress appropriated $1 billion in March for the production of testing and medical supplies under the Defense Production Act, the administration has used only $212 million on medical supplies, Democrats wrote on Tuesday.
"We are concerned that the Administration has not allocated sufficient funds to boost short-term and longterm domestic production of critical medical supplies and equipment to meet the overall public health needs of the United States," a group of House Democratic committee chairs wrote to the Secretaries of Defense and Health and Human Services on Tuesday, seeking information about plans to boost medical supplies.
The White House declined to comment on the record about the use of the Defense Production Act.
Last week Pence appeared to paint a rosier picture of the PPE situation, saying at a coronavirus briefing that "PPE, we hear, remains very strong." But the vice president did say they were "encouraging health care workers to begin now to use some of the best practices that we learned in other parts of the country to preserve and to reuse the PPE supplies."
The White House's response to the supply chain problems, including the now-shuttered Project Airbridge effort to airlift supplies earlier in the crisis, has already come under scrutiny from Democratic lawmakers.
Earlier this month, Democrats on the House Oversight Committee released a report on Airbridge that concluded the federal government failed to provide guidance to private sector partners on distribution and shortages, resulting in a chaotic free-for-all on the global PPE market between states.
Representatives for some of the country’s largest medical supply distributors that participated in the initiative raised concerns about the price and supply of raw materials used to manufacture protective gear, which could make their work unsustainable, the report said.
Rear Adm. John Polowczyk, who leads the White House Supply Chain Task Force, told lawmakers that 70 to 75% of states had at least 30 to 60 days of protective gear in reserve, and suggested that concerns from some medical workers did not comport with the federal government’s data. He also said the federal government still lacked some state-level data on N95 and PPE supplies.
A FEMA document of projected supplies and demands for protective gear -- separate from the one obtained by ABC News and made public by the agency at the urging of Sen. Maggie Hassan, D-N.H. -- said that the demand for gowns “outpaces current US manufacturing capabilities,” and that there is no U.S.-based manufacturing for synthetic rubber gloves.
FEMA touts PPE figures in the millions, but the problem could be in the billions
In a statement to ABC News on Tuesday, FEMA said, “The Supply Chain Stabilization team is continually working with interagency partners to increase domestic manufacturing of PPE. Demand is overtaking supply because hospitals, states, and the federal government are stockpiling PPE.”
“As of July 14th, FEMA and HHS have coordinated the delivery of, or are currently shipping: 103.1 million N95 respirators, 159.3 million surgical masks, 17.2 million face shields, 74.5 million surgical gowns/coveralls, 139.4 million gloves, 34.2 million KN95 respirators, 13.8 million KN90 masks and 2.4 million thermometers,” the agency said in a statement.
Hospital workers and nurses say it hasn't been enough.
Get Us PPE, a nonprofit that delivers protective gear to front-line workers, has seen a 200% increase in requests from Florida, Arizona and Texas since May – with a majority coming from rural hospitals and nursing homes, rather than large hospital systems.
“The denominator of hospitals and facilities who need this continues to grow,” said Dr. Ali Raja, a co-founder of the organization and executive vice chair of the Department of Emergency Medicine at Mass General Hospital. “Even if supply is picking up, it has in no way met demand.”
In March, Dr. Robert Kadlec, the assistant secretary for preparedness and response at HHS, told lawmakers that the country would need 3.5 billion single-use N95 masks for the pandemic, and had less than 1% in the national stockpile at the time.
But that estimate may have been low, Prakash Mirchandani, the Director of the Center for Supply Chain Management at the University of Pittsburgh, told ABC News, pointing to the need for similar protections in nursing homes and other non-hospital medical facilities.
“If you would have asked me one year ago whether that would happen in the U.S., I would have said zero chance,” he said of the supply chain shortages. “In a country which really values research and a great health care system, it’s happening, unfortunately."
Copyright © 2020, ABC Audio. All rights reserved.
BlackJack3D/iStockBY: DR. SHANTUM MISRA, ABC NEWS
(NEW YORK) — The novel coronavirus has now infected over 13 million people around the world. But can they contract the virus again?
It seems that every day there is a new story about a person who is diagnosed with COVID-19 infection for a second time. Last week a physician from New Jersey claimed that two of his patients contracted the virus again, just two months after recovering from their initial infection. Similar stories have circulated around the country, prompting people to question whether they are truly safe from re-infection after an initial bout with the disease.
So far, experts say these anecdotes don’t amount to definitive proof.
“It’s certainly not cause for alarm,” said Dr. William Schaffner, a professor of preventative medicine and infectious diseases at Vanderbilt University Medical Center. “We have anecdotes where the scientific basis is partial, but it’s not really tied up in a nice red bow. It’s not complete.”
Now experts are scrambling to understand just how long people are protected from infection after they’ve already recovered from COVID-19.
Infection with COVID-19, or any virus for that matter, prompts the body to activate one's immune systems to attack the active virus directly and also create antibodies, some of which may help protect us against future infections.
Scientists don’t yet know for sure if it’s possible for people to be infected a second time, but two recent studies – one from China and one from the United Kingdom – found that the antibodies that fight against future infection faded within a few months.
The first study, from Wanzhou, China, and published in Nature Medicine, found that neutralizing antibodies faded quickly – after just eight weeks – in both asymptomatic and symptomatic people. And a study published by King’s College in London, which has not yet been peer-reviewed, found that neutralizing antibody response may begin to decline just three to four weeks after COVID-19 symptoms initially emerge. The study also found a more durable antibody response in patients with more severe symptoms.
Although these recent studies have hinted that our antibodies may diminish faster than many had hoped, experts say antibodies are not the whole story, and it’s possible that other parts of the immune system might still offer some level of protection.
“The duration of immunity is unclear, but it does make sense that we may start seeing cases of re-infection with the novel coronavirus, as with other common coronavirus infections," said Dr. Todd Ellerin, director of infectious diseases at South Shore Hospital. In theory, given a long enough time after recovery, re-infection is “plausible,” he said.
The novel coronavirus, or SARS-CoV-2, belongs to a large family of coronaviruses that are known to cause illnesses varying from the common cold to severe infections such as severe acute respiratory syndrome, or SARS.
Based on research from other coronaviruses, experts say there is a wide range in how long immunity lasts after an initial infection. For several of the common cold causing coronaviruses, prior infection might protect you for about six to 12 months. Other types of coronavirus – such as the Middle Eastern Respiratory Syndrome, or MERS virus – may, however, result in several years of immunity.
Given this variation, there is ongoing research to determine if the virus that causes COVID-19 will behave more like MERS or more like the common cold.
Experts caution that immunity from a viral infection is a complex, multifold process. Although the exact length of immunity after COVID-19 infection is not yet determined, it is certainly possible re-infection may occur.
That means even people who have recovered should exercise caution, practice social distancing, wear masks and wash their hands, according to the Centers for Disease Control and Prevention.
“Having it once does not give you free reign to go out and act as if there is no coronavirus around. I think we still need to take precautions because there is still a lot we don't know," said Dr. Simone Wildes, an infectious disease physician at South Shore Health.
Although recovery after a confirmed coronavirus infection “certainly provides immunity over a short term,” people “should not change [their] infection prevention behaviors,” said Ellerin. “Re-infection at some point in the future remains a possibility.”
Experts agree that we won’t know whether reinfection is possible until the virus has been with us for years, rather than months. But with over 13 million confirmed cases worldwide and limited anecdotes of possible re-infection, so far large-scale series of cases of re-infection have not occurred – a somewhat reassuring sign.
“We don’t know whether COVID will follow the same pattern" as other coronaviruses, said Schaffner, but “it wouldn’t surprise a lot of people” if it did.
Shantum Misra, M.D., is a senior resident in internal medicine at Dartmouth-Hitchcock Medical Center and a contributor to the ABC News Medical Unit.
Copyright © 2020, ABC Audio. All rights reserved.
Hiraman/iStockBy JACQUELINE LAUREAN YATES, ABC News
(NEW YORK) -- If you've ever wondered if there is a day to celebrate clean beauty... there actually is.
On July 15, people nationwide will celebrate National Clean Beauty Day. This day was created with an aim to educate consumers about the importance of conscious cosmetics consumption.
Additionally, the day exists to encourage the industry to adopt earth-friendly practices and use more organic ingredients within their routines.
Pioneering beauty and wellness platform Juice Beauty teamed up with National Today to make Wednesday this year's designated day with hopes of raising all-around awareness on the clean beauty movement.
"When I founded Juice Beauty 15 years ago, the clean beauty movement didn't exist," said Juice Beauty founder Karen Behnke in a statement. "I turned my wellness passion to beauty, bought the trademark Juice Beauty, and started the company from scratch."
She continued, "My premise was that filling with organic botanical juices and powerful plant-based ingredients would yield higher efficacy than conventional chemical products and have the added benefit of protecting humans, animals and the planet."
Today, Juice Beauty carries a wide array of award-winning organic skincare products to treat issues ranging everywhere from uneven skin tone to acne and blemishes.
Clean beauty amid COVID-19
Amid the coronavirus pandemic, most people are on higher alert when it comes to the people, places and even products they are being exposed to. With that, many consumers have been interested in learning more about clean beauty products in best practices.
Detox Market (a clean beauty retail haven) founder Romain Gaillard told GMA, "Ultimately, clean beauty is rooted in safety and wellness, which are top of mind for consumers during the COVID era."
He continued, "We are seeing customers starting to seek out alternative options they can trust. If the pandemic has shown us anything, business-wise, it's that consumers are smart and very discerning — and they want to learn."
GMA also tapped founder and CEO of clean beauty Beautycounter Gregg Renfrew, who shared similar thoughts, saying: "Clean is now top of mind, along with protecting the health and safety of their families. [Consumers] want to make sure whatever enters their home, their bodies, their communities, is not going to adversely impact their health."
"They will continue to seek out brands dedicated to transparency, and expect more of the brands they shop with," she added. "Beautycounter has always led the clean beauty movement and we will continue to educate consumers on how and why making a switch to clean remains so important."
Clean up your routine with these top 5 brands:
In case you are wondering where to start when it comes to cleaning up your own beauty routine, scroll ahead for a curated list of five standout earth-friendly companies that are committed keep you safe and chic.
Beautycounter is another leader within the clean beauty space with a continual mission to get safer products into the hands of more people.
The multi-level marketing company retails cosmetic as well as skincare products with over 100 product offerings that don't contain any harsh chemicals and do include all-natural ingredients that are ethically sourced.
In July, Beautycounter and Sephora announced a partnership where both industry innovators will join forces for a limited-time pop up on Sephora.com and in Sephora stores starting Aug. 7 with a curated 11-product assortment of their best-selling products.
New products from the company include the All Bright Vitamin C Serum as well as the Countersun Daily Sheer Defense SPF.
Known as "the new face of clean," Bite Beauty has become one of the most sought after clean makeup brands.
People love this line because the company carries products that are high performing and deliver lots of color payoff.
All products are vegan, gluten free and cruelty free.
This Black woman-owned skin and body care line has everything you need to elevate your self-care routine.
Hanahana Beauty is committed to empowering women of color and produces all handcrafted 100% natural products.
The company was also featured on Beyonce's directory of Black-owned businesses to support.
Standout products include the shea body butters as well as soaps.
It's hard to discuss clean beauty, without including Tata Harper somewhere within the conversation. The brand's motto is "beauty without compromise," and that's exactly what it is.
Tata Harper Skincare is cruelty-free, nontoxic and 100% natural.
The collection includes everything from cleansers and moisturizers to body scrubs and oils.
A longtime favorite from many is Tata Harper's BHA Enzyme Brightening Mask. It's best for clearing out blocked pores and smoothing out rough skin.
Throughout the past few years, Farmacy Beauty is growing into a household name for many clean beauty enthusiasts. The company has lots of skincare offerings that are mainly sourced straight from farm-fresh ingredients.
Farmacy Beauty's philosophy is powered by the best of nature and science, cruelty-free and marked "clean" at Sephora.
Most recently, the brand launched a new hand sanitizer formulated to kill 99.9% of germs. One hundred percent of proceeds from sales will be donated to a network of local food banks and hunger relief organizations.
Copyright © 2020, ABC Audio. All rights reserved.
ASphotowed/iStockBy LAURA ROMERO and DR. JAY BHATT, ABC News
(NEW YORK) -- Communities of color have been bearing the brunt of the coronavirus since the pandemic began, and as multiple states across the country are seeing record-breaking spikes in COVID-19 cases, doctors are seeing a new trend: Young people of color with underlying medical conditions are being hit harder by the virus than their peers.
People of any age with preexisting conditions, like diabetes, obesity and heart disease, are at an increased risk of severe illness from COVID-19 because of the effect those conditions have on a person's immune system. Data released by the Centers for Disease Control and Prevention in May showed that COVID-19 patients with those same preexisting conditions are more likely to need treatment in a hospital -- or even in an intensive care unit.
But for younger people of color, who are more likely to experience chronic health conditions associated with poor outcomes from COVID-19 at higher rates, the reality is particularly grim.
"You combine long-standing health inequities and a health system with essential worker status and with underlying conditions, it is a perfect storm for a population we really need to look out for," said Dr. Atul Nakhasi, a primary care physician and policy adviser at the Department of Health Services in Los Angeles, the nation's second-largest health system that serves a low-income area.
As of mid-June, age-adjusted hospitalization rates released by the CDC were highest among non-Hispanic American Indian or Alaska Native and non-Hispanic Black persons, followed by Hispanic or Latino persons, suggesting minority groups regardless of age have higher rates of hospitalization or death from COVID-19 than non-Hispanic white persons.
A recent ABC News state review found that while the majority of hospitalized patients remain older Americans, and nationally the death rate in the younger age group remains extremely low, several state and hospital officials across the nation are increasingly reporting that young people are not just contracting the virus, they are getting sick.
And because several states across the nation are seeing more and more youths come through hospital doors, it's people of color with underlying conditions who are at an increased risk of getting the novel coronavirus and experiencing severe illness.
For Latinos, who already bear a disproportionate share of coronavirus cases, the data is particularly alarming since they are among the youngest racial or ethnic groups in the U.S., according to a study from Pew Research Center.
Several experts told ABC News that the issue stems from the link between health and wealth in the United States.
Matthew G. Heinz, an internist at Tucson Medical Center in Arizona, who said he has been admitting younger patients at an alarming rate, said that health and social inequities are putting younger minorities at higher risk.
"I think a lot of it could derive from decades long of leftover health disparities," said Heinz. "Just a lack of consistent access to good primary care, medical care, regular checkups. When you lack that as a population, you will see a lot of underlying medical conditions which makes you ever so much more attractive to COVID. It loves diabetic, obese, hypertensive patients."
In an analysis of data released by the state's Department of Health, Florida Today found that as of early May, of the 25 people age 40 or younger who had died from the coronavirus in Florida, most suffered from asthma, chronic bronchitis, morbid obesity and hypertension -- conditions that disproportionately affect people of color.
These underlying medical conditions are highly prevalent in low-income Americans, according to a study released by the Robert Wood Johnson Foundation. In 2018, Hispanic/Latino Americans accounted for 19% of total people living in poverty in the U.S., Black Americans accounted for 22% and Asian/Native Hawaiian and Pacific Islander accounted for 11%, according to the Kaiser Family Foundation.
Dr. Rhea Boyd, a pediatrician at the Palo Alto Medical Foundation Clinic in California, said many of those preexisting conditions are driven by the social conditions.
"Some of the structural factors are like environmental racism because of residential segregation and zoning ordinances," Boyd told ABC News. "These populations are also disproportionately exposed to toxins and pollutants. And studies show that chronic exposure to air pollution increases COVID-19 mortality rate."
Nakhasi said improving access to health care for minorities should be a priority.
"We have a long way to go in this country to improve health inequities and health care access to underserved communities, low-income communities, urban communities," Nakhasi told ABC News. "If it's harder to show up to the doctor, if it's harder to build that rapport to your primary care physician, if it's harder to get health care, access and insurance, it's going to be harder to diagnose you and treat you effectively, quickly and efficiently."
Copyright © 2020, ABC Audio. All rights reserved.
sturti/iStockBy SOO RIN KIM, LAURA ROMERO and OLIVIA RUBIN, ABC News
(NEW YORK) -- As data shows more and more younger people are getting infected by the novel coronavirus, health experts are trying to bust a myth that they say has stifled the global health crisis response: that young people can’t get seriously ill from the virus that has killed more than 574,000 people around the world.
While the majority of hospitalized patients remain older Americans, and nationally the death rate in the younger age group remains extremely low, several state and hospital officials across the nation are increasingly reporting that young people are not just contracting the virus -- it's making more and more of them ill enough to be admitted to hospitals.
“Everyone who is young in that age group has the same idea of ‘I’m young, I’m not gonna get it, [and] if I do get it, it’s not gonna be that bad,’” said Dr. Michael Seemuller, a doctor at AnMed Health in South Carolina and the chair of Quality and Safety for its physician network. “And then they get it and they end up in the hospital.”
Officials and doctors in some states like California and Colorado told ABC News they haven't seen a marked increase in admissions for young patients lately. But government or hospital officials at least a half dozen states -- out of 18 that provided hospitalization data, some broken down by age, to ABC News -- said they see more and more youths come through their doors, including hard-hit states like South Carolina, Texas and Louisiana.
Seemuller said that younger people's potential susceptibility to severe complications from the virus was there from the start, even if many didn't realize it.
“People have always been admitted to the hospital in that age group, and no one wanted to listen to that,” Seemuller said. “The early message was that young people will be fine but that's just not true.”
Beyond being potential carriers of the disease that could endanger older Americans, the experts said the younger population itself is still susceptible to long-term effects from COVID-19, such as damaged lungs as well as blood clots that can lead to big and small heart attacks or strokes.
“I think the message we've been really trying to get to that age group, is that there are lots of things we don't know about the virus, that it's not safe,” Louisiana Assistant Health Secretary Dr. Alex Billioux told ABC News. “As we learn more and more, actually, we learn about potential long term impacts from COVID. That, I would think, would personally be very scary for any age group.”
In one of the worst coronavirus hot spots right now, Dr. Matthew Heinz in Tucson, Ariz., said he admitted six COVID-19 patients in their 20s just this past Sunday, the highest number he’s seen in one shift.
“It was just striking because I usually get one or two younger patients every time there's a cluster of COVID patients but in this case, it was basically all of the COVID patients I had just happened to be 25, 28-year olds,” Heinz told ABC News.
“One of the 25-year-olds I admitted during my shift looked terrible,” said Heinz. “He looked like he had a horrible, nasty, nasty flu and was requiring four or five liters of oxygen. And this is a young, healthy guy.”
Heinz said he too believes younger people who gather in large crowds and attend social parties, think they are immune and are contributing to the increase in hospitalizations since Arizona reopened in May.
“So it’s about 21 days from the time of the party, the initial offense when hospitals will see the effects,” said Heinz, describing a hypothetical example. “That means people will go out once, think that they are fine because they don’t feel sick immediately and keep going out and congregating in large numbers. Since my state has reopened, those infections keep coming in the door and they’ve never stopped.”
Across the state in Arizona, people over the age of 65 still make up the largest chunk of hospitalized COVID patients -- more than 40% -- but those between 20 and 44 years old also make up 20% of COVID patients currently hospitalized, state-released data shows.
In Texas, which has also been hit hard this summer, Dr. Faisal Masud, the head of the Center for Critical Care at Houston Methodist Hospital, said back in March and April, 60 to 70% of the patients around the greater Houston metropolitan area were people over the age of 55, and just around 20% were less than 50. In June and July, the percentage of those under 50 is hovering around 40%.
“That’s a pretty remarkable shift,” Masud said. “It's a significant amount of admissions to the hospital of people who should not be in the hospital.”
Masud said a key factor in the rising hospitalization among the younger population is that there’s a large number of young people who are obese and have a significant history of smoking or vaping, as well as asthma or kidney conditions, which could contribute to raising the chance of developing a severe illness from the coronavirus.
“What I tell people is that COVID-19 is an equal opportunity killer,” Masud said. “The myths of security of age are gone. The myth that summer will come and the virus will die out, that is defeated. The myth that even if I get it I will not get sick, that's been defeated.”
In Louisiana, Billioux told ABC News that while the state doesn’t have a breakdown of hospitalization by age, the fact that overall hospitalization is rising at a similar rate as the rise in cases -- when younger people are growing rapidly while older people are flattening -- is a sign that hospitalization has been skewing younger as well.
“It's very rare for that age group [between 18 - 29] to have severe complications but when we start to see such large numbers of individuals with COVID, it means that you're going to see more individuals in that age group with complications, just statistically,” Billioux said. “Even if it's a rare event, if you increase a number of events, you're going to see more of it.”
As of July 13, patients under the age of 30 made up nearly 30% of all cases in Louisiana, with the age group between 18 and 29 being the largest chunk among different age groups, state-released data shows.
Similarly in Minnesota, where cases among younger people exploded in the past month, the median age of hospitalization decreased from 63 in the first week of April to 54 in the last week of June, the state health department’s spokesperson Julie Bartkey told ABC News. In comparison, the median age of deaths has remained in the low 80s over the months.
In New Jersey, where nursing homes had been struck hard earlier in the pandemic but have since been recovering under lockdown and extra safety measures, the average age of hospitalized COVID patients decreased from 66.5 in April to 55 in June, while the average age of deaths dropped at a slower rate, from 78 in April to 74 in June, the state’s health department spokesperson Nancy Kearney told ABC News.
But hospitalization and deaths among younger patients in New Jersey still only make up a very small percentage of the total -- only around 4% of those hospitalized from COVID are under the age of 30, Kearney added.
Meanwhile, in other states where cases and deaths have been raging this summer, officials report that they have not seen a huge shift in hospitalization toward the younger population. Some states that haven’t seen as much, like Colorado and Idaho, also say their age distribution has remained mostly flat.
In California, the average age of hospitalized COVID patients has slightly decreased from 64 at the beginning of the pandemic, to 57 in early July, but mostly remained steady over the months, according to the state’s Public Health Department.
Dr. Brad Spellberg, chief medical officer at Los Angeles County and USC Medical Center, said his hospital has not seen much of a shift to younger patients, but partly because it has had a higher number of younger patients to begin with.
“This may be, in part, because as a public hospital, we generally tend to have younger patients at baseline,” Spellberg said. “Since the beginning of the pandemic we’ve seen teenagers, people in their 20 to 30s, and all the way up to their 80s. And we’re still seeing that same mix.”
In Florida, while the percentage of hospitalized COVID patients under the age of 44 has not changed drastically. At the beginning of April, they made up about 15% of total hospitalized, and as of July 13, the number has gone up to 18%, according to state-released data.
But hospitals like the Tampa General Hospital have seen high numbers of younger patients come in since Memorial Day.
"We are seeing younger patients that are getting sick," Dr. Myers, director of inpatient COVID care at Tampa General Hospital, told ABC News. "We've had people in their 20s that are intubated and then people in their 90s that go home okay."
But as officials and experts from different states see a varying degree of younger population getting hospitalized from COVID, one point that has been observed across the board is that more and more younger people are testing positive and carrying the virus through their communities. And health experts stress the importance of a consistent public messaging critical in addressing this problem.
“What I've come to understand is people listen to what they want to listen to, and that is a challenge,” Masud said. “And with mixed messaging all up and down everywhere, I can totally understand that they choose to agree to certain messages and do not agree to other messages.”
“It is very important for people to understand that our communities have the power to change that trajectory,” Masud said. “We all love freedom, but freedom can't go before responsibility.”
Copyright © 2020, ABC Audio. All rights reserved.
Chip Somodevilla/Getty ImagesBy EMILY SHAPIRO, ABC NEWS
(WASHINGTON) -- Robert Redfield, director of the Centers for Disease Control and Prevention, believes "the most powerful weapon we have" against the novel coronavirus is wearing face coverings, washing hands and "being smart about social distancing."
"If we all rigorously did this, we could really bring this outbreak back to where it needs to be," Redfield told the Journal of the American Medical Association via video on Tuesday.
Coronavirus cases are surging across the U.S., from California to Texas to Florida. More than 3.4 million people in the country have been diagnosed with the coronavirus and over 136,00 people have died.
To Redfield, a major key to controlling the pandemic is wearing masks.
"I really do believe if the American public all embraced masking now and we really did it, you know, rigorously ... I think if we can get everybody to wear a mask right now, I really do think over the next four to six, eight weeks, we can bring this epidemic under control," Redfield said.
The CDC director stressed that wearing a mask is "not a political issue -- it is a public health issue," calling it a "personal responsibility" for everyone.
"I'm glad to see the president wear a mask this week, and the vice president," Redfield said. "We need them to set the example."
President Donald Trump wore a mask for the first time in public over the weekend on a visit to Walter Reed Medical Center.
Looking ahead, Redfield said he's worried about the upcoming fall and winter, when flu season begins.
"I do think the fall and the winter of 2020 and 2021 are going to be probably one of the most difficult times ... in American public health because of ... the co-occurrence of COVID and influenza," he told JAMA.
Redfield stressed the importance of getting the flu vaccine, "because I think those two respiratory pathogens hitting this at the same time do have the potential to stress our health system."
ABC News' Eric Strauss contributed to this report.
Copyright © 2020, ABC Audio. All rights reserved.
FG Trade/iStockBY: DR. STEPHANIE E. FARBER, ABC NEWS
(PITTSBURGH) — With stay-at-home orders leaving many bemoaning their webcam appearances, plastic surgeons have seen a rebound in demand for procedures with the reopening of their offices.
“Across the country there has been some pent-up demand," said American Society of Plastic Surgeons President Dr. Lynn Jeffers. "Our statistics show that people are still interested.”
Jeffers said breast augmentation and liposuction top the list of most common procedures, according to surveys of plastic surgeons' offices from across the country compiled by the American Society of Plastic Surgeons.
“Even during this pandemic the interest in plastic surgery has not waned," she noted.
Millions of Americans get Botox injections and breast augmentation every year. Following strict stay-at-home orders in March and April, many hospitals and doctors' office across the country have since resumed these elective procedures, particularly in places where infection rates are relatively stable.
According to the American Society of Plastic Surgeons, 55% of plastic surgeons across the country reported that Botox injections were the most commonly sought treatment during the stay-at-home order, followed by 40% who reported that breast augmentation was the most frequent request.
These expectations align with prior plastic surgery trends. Botox injections and breast augmentations were the most common procedures in 2019 for nonsurgical and surgical categories, respectively. Nearly 8 million botox injections and nearly 300,000 breast augmentations were performed last year.
Dr. Heather Furnas, a plastic surgeon at Plastic Surgery Associates in Santa Rosa, California, and an adjunct clinical professor of plastic surgery at Stanford University, agrees.
“It’s like there was this pent-up demand for surgery – breast augmentation, breast lifts, tummy tucks . . . demand is huge," she said. "We filled up immediately.”
Furnas feels that stay-at-home orders may have contributed to this phenomenon.
“Some of them will say they see themselves on Zoom and they just want to feel better," she explained. "In this crazy time, I think people are looking for something to make them feel better about themselves.”
But as patients grapple with the economic impact of the pandemic, Jeffers predicts a higher proportion of patients will opt for less expensive and less invasive procedures initially.
“Bridging procedures like Botox and fillers – patients will want things like that until they are more secure,” she said.
And beyond cosmetic procedures, plastic surgeons are grateful to be able to resume other procedures as well, such as reconstructive plastic surgery for an injury or for breast or skin cancer.
As the pandemic swept the nation and all elective procedures were canceled, plastic surgeons say the blurred lines between essential and nonessential surgeries led to many difficult decisions.
“If somebody came in with something traumatic, it obviously had to be dealt with. The harder things were skin cancer, early breast cancers – at what point can you delay them and at what point must you move forward,” Jeffers explained.
These decisions were difficult because “no one knew how long this was going to last," she said. "Certain things can be put off for a month but they can’t be delayed for three or five.”
Many of these patients who had their cancer surgeries and reconstructions delayed are now part of a backlog that plastic surgeons like Jeffers are trying to tackle.
“We still don’t know the whole aftermath of that and how many people had certain amount of delayed care from a cancer perspective,” she said.
Meanwhile, the pandemic has somewhat normalized remote medical visits, in which patients video conference with their doctors to talk about their medical concerns and see if they can be addressed remotely.
Now, many plastic surgeons hope that virtual medicine is here to stay because it might increase access to treatments among people who live in more remote areas.
Although telemedicine can help relieve some of the demand for in-person visits, there are certain procedures and consultations that must be done in person. Plastic surgeons say they can be done safely by following CDC guidelines to prevent the spread of infection.
What you should know if you want to visit a plastic surgeon
For those wishing to see a plastic surgeon in the near future, Furnas said, “Find out what their protocol is. They should be informing you in advance to come with a mask, that they will be taking your temperature, and they will be screening your symptoms.”
The American Society of Plastic Surgeons put out guidelines for plastic surgeons to get back to work safely and Jeffers encouraged patients to ask their plastic surgeons about the safety procedures they have in place.
Furnas also said that not every patient will be a good candidate for elective surgery during a pandemic.
“Sometimes patients will push to do more than can safely be done," she said. "We do really look at comorbidities and so occasionally we will tell somebody, 'Why don’t we wait?’”
Furnas and Jeffers are both pleased to be providing patients with a source of happiness during these challenging times.
“The best part of being a plastic surgeon is seeing the happiness of the patient afterwards ... seeing them smile in this time is just really, really gratifying,” Furnas said.
Stephanie Farber, M.D., is a plastic surgeon from Pittsburgh and is a contributor to the ABC News Medical Unit.
Copyright © 2020, ABC Audio. All rights reserved.
stockstudioX/iStockBy KATIE KINDELAN, ABC News
(NEW YORK) -- Whether or not it is safe to return to the gym has become a puzzling question for people as the number of COVID-19 cases continue to rise in many states.
In Florida, one of the epicenters of the pandemic, where the positivity rate now stands at 18.3%, the state's phase 2 reopening order that went into effect in June allows gyms to operate at full capacity.
In another COVID-19 hotspot, Arizona, the state's governor included indoor gyms among the list of businesses forced to pause operations as the state sees a surge in new COVID-19 cases and hospitalizations.
As researchers learn more about COVID-19, some are also pointing to growing evidence that the virus may be spread through small aerosolized particles, also called airborne transmission, which could pose a problem in enclosed places like gyms.
How to know if it's safe to return to the gym
People who live in areas where COVID-19 still has a major presence and people who fall under the high-risk category -- those age 65 and older and people with preexisting conditions like heart disease and diabetes -- should exercise caution when it comes to returning to a gym or boutique fitness studio, according to Dr. Simone Wildes, a Boston-based infectious disease specialist.
"My take right now is it really depends on where you live," she said. "Here in Massachusetts, our numbers are really good, meaning we don't have as many cases and the trends have been really good for the last couple of weeks. I feel comfortable going to the gym here."
"On the flip side, if I live in Florida, Arizona, Texas, where the numbers keep escalating, I really don't think it's a good time to go to the gym right now," Wildes said.
Wildes said the key to knowing when it is safe to exercise inside a gym comes down to following the science and knowing what is best for you, including whether you are high-risk and whether your gym is following proper safety protocols.
"Don't just say, 'It's open so it's fine for me,'" she said. "Not everybody follows the same guidelines. ... You have to be careful to make sure that all the steps and protocols are really sorted out and you feel safe as an individual to go there."
The risk of transmission of COVID-19 at the gym comes not as much from sweat but through frequently touched surfaces, like weights, strength machines and treadmills, that you may touch and then touch your face, eyes, nose and mouth, increasing the risk of contracting the virus, according to Wildes.
It is also more difficult to maintain the recommended 6 feet of physical distance from another person inside a gym than it would be outdoors or inside your own home. The main way the virus is spread is through respiratory droplets via coughing and sneezing, but also when breathing hard and forcefully exhaling, as commonly occurs during exercise, experts say.
Some gyms are requiring users to make reservations ahead of time, which Wildes pointed to as a best practice for minimizing crowds.
Gymgoers should wear masks at all times, except when they are doing cardio at a socially distant machine, according to Wildes. They should also be flexible with their plans, because whether or not it is safe to go to their local gym may change from day to day or week to week.
"We have to pretty much assess daily what's going on," she said. "Things change rapidly as we've all seen with COVID-19."
Data shows that outdoor and socially distant activities are the safest, so this summer is the best time to pick up activities like swimming, cycling, running and walking that can be done outdoors and far apart from others, according to Wildes.
"Physical exercise is so important and I want people to go out and do exercise," she said. "Smaller groups, using good hygiene and being socially distanced outside are best."
If you are ready to head back to the gym, here are Wildes' four recommendations to stay as safe as possible.
1. Practice safe social distancing: Maintain a distance of at least 6 feet from other people in the gym, Wildes recommended.
2. Clean equipment before and after use: "Definitely clean the equipment before and after use and use hand sanitizer between equipment use. Make sure the gym has hand sanitizer supplies and hand-washing stations easily available. You shouldn't have to walk down the aisle or through people to access those."
3. Wear a cloth face covering: "The CDC has recommended that a cloth face covering be worn in public settings where other social distancing measures will be difficult to be enforced, especially in areas of significant community-based transmission. Wear cloth face coverings that you can breathe through comfortably and your nose and mouth are fully covered. The mask should fit snugly against the sides of your face so there are no gaps."
"The face covering should be either tied or secured to prevent slipping while working out. Wash mask after use. Try not to touch your eyes, mouth or nose when removing the mask from your face and wash or sanitize your hands immediately after removal."
4. Make sure your gym is taking all necessary precautions: Wildes recommends reading your gym's COVID-19 guidelines to make sure the below questions are answered, and asking the gym directly if they are not.
- How is the gym limiting the number of individuals in the facility while maintaining social distancing requirements and how will this be managed?
- Are there temperature checks and symptom checks done in order to enter the gym?
- Are there signs and floor markers in place to help members?
- What are your cleaning protocols? Will equipment be cleaned before and after use with EPA-approved disinfectants? Any additional cleaning with UV lighting?
- How are staff members protected -- i.e. the cleaning staff, personal trainers and front desk staff -- from coronavirus and will they be given personal protective equipment?
- Do you have a return-to-work policy in place for employees that are COVID-19 positive?
- Will there be continual training and updates for staff on COVID-19?
- Will there be group exercise or small group trainings happening?
- How is social distancing on free weights and cardio machines enforced?
- Are all members required to wear a face mask during workouts and do you have masks on hand for those without them?
- Are there extra fans in place and will doors and windows be opened to keep air moving?
- What is the communication protocol for informing members of the gym if others members are diagnosed with COVID-19?
Copyright © 2020, ABC Audio. All rights reserved.
Eblis/iStockBy KATIE KINDELAN, ABC News
(NEW YORK) -- When Tara Travieso was trying to explain social distancing to her 2 and 3-year-old daughters and what it meant for their lives -- from no play dates to no school -- she wanted to explain it to them in a way that would make them aware, but not scared.
Travieso, of Jacksonville, Florida, decided to use something she knew her daughters Alex and Addison love: bubbles.
"I painted this picture by saying pretend that there’s a bubble around you that’s going to keep you safe," Travieso, a benefits consultant, told Good Morning America. "We’re all in our own bubbles right now and it keeps the germs outside of our bubbles and if we’re sick it keeps the germs inside of our bubble so we don’t get other people sick."
"If you get too close to someone the bubble could pop and we don’t want to pop our bubble," she said she told her daughters. "I mentioned it one day on a walk in the neighborhood and the next day my older daughter Alex brought it up to me and said, ‘We can go on a walk but we have to stay in our bubbles.’"
When she saw how quickly her own daughters took to the idea, and got positive feedback from other parents with whom she shared the idea, Travieso got to work writing a children's book.
Just six weeks later, Travieso self-published her first book, Billie and the Brilliant Bubble: Social Distancing for Children.
"I knew that it was relevant right now and that if I was going to help people I had to get it out quickly, so I felt a lot of pressure to put this book together and get it out and available as quickly as possible," she said. "It took me six weeks from the moment I had the idea to the day that I published and I had had no experience in this world before."
Travieso researched online to find out how to write and publish a book herself, reading articles and watching YouTube videos to figure out everything from getting an ISBN number for the book to deciding on its size. She and her husband Robert are both working full-time at home while also caring for their daughters due to the pandemic, so she wrote the book late at night, often after midnight when her kids were in bed and her work was done.
The book -- which is available on Amazon.com and other online retailers and in bookstores across the country -- tells the story of a young girl named Billie who has an imaginary bubble to keep her safe, according to Travieso. It follows Billie as she goes to a park and meets new friends, who learn about her imaginary bubble and then want one themselves.
Travieso used a freelancer website to find an illustrator and worked with Bazma Ahmad, a mother of two in India with whom Travesio said she bonded immediately.
"She has two boys and we related very quickly in many ways," she said of Ahmad. "I wanted every page in this book to be beautiful, to be really eye-catching and to be able to hold a child’s attention."
Travieso said she has heard from schools who would like to feature the book in their classrooms and from parents who are happy to have a way to explain today's difficult times to their children in a way they can understand.
Travieso is now using the idea of imaginary bubbles to talk with her own daughters about a brighter future ahead.
"We talk about when we’re all going to pop our bubbles, all the fun things we're going to do and it’s something to look forward to," she said. "My daughter will say, ‘Well when our bubbles pop we can go out to a fancy restaurant.’"
Copyright © 2020, ABC Audio. All rights reserved.
iStock/niratBy: IVAN PEREIRA, ABC News
(ATLANTA) -- A judge struck down Georgia's controversial ban on abortions after six weeks of pregnancy.
District Judge Steve C. Jones said the state law, H.B. 481, was unconstitutional as it violated several stipulations set forth by Roe v. Wade, the 1973 Supreme Court case that codified abortion as a protected right.
"After considering H.B. 481 as a whole, the title, the caption, the prior legislation, the legislative scheme, the old law, the evil, and the remedy, the Court rejects the State Defendants' argument that the statutory purpose solely concerns "promoting fetal well-being," he wrote in his decision.
The law was supposed to go into effect at the beginning of the year but was blocked while the courts heard the suit filed by several groups. Under the legislation, abortions would be banned after six weeks, which is approximately when a doctor may be able to detect a heartbeat from a fetus.
The law had exceptions for rape and incest; however, the patient would have to get a police report in that circumstance.
Abortion rights activists who sued the state, including the American Civil Liberties Union and the Center for Reproductive Rights, contended the law was made to undermine Roe v. Wade and restrict the right to choose.
"The district court blocked Georgia's abortion ban, because it violates over 50 years of Supreme Court precedent and fails to trust women to make their own personal decisions. This case has always been about one thing: letting her decide," Sean J. Young, the legal director, ACLU of Georgia said in a statement.
The law, which passed with a 92 to 78 vote last year, generated an outcry from business leaders, including Hollywood heavyweights, who threatened to leave the state over the measure.
A spokesperson for Gov. Brian Kemp told ABC News in a statement his office will appeal the ruling.
"Georgia values life, and we will keep fighting for the rights of the unborn," spokesperson Candice Boce said in a statement.
The decision on the Georgia ban came two weeks after the U. S. Supreme Court struck down a Louisiana law that required abortion providers have admitting privileges with a nearby hospital. The judges ruled in their decision that third-party standing, which means that a third party -- like an abortion provider -- is allowed to argue on behalf of the person impacted, applied in the Louisiana case.
Jones, the judge in the Georgia case, said when the case was heard in June that he would wait for the Supreme Court to decide on the third-party standing issue before he made a decision about the Georgia law.
Abortion rights activists also scored a legal victory in Tennessee Monday after a federal judge issued a temporary restraining order on a law passed the same day that also banned abortions after six weeks. The Tennessee law also blocked patients from having an abortion based on rape or incest.
"It is unconscionable that — in the middle of a public health crisis and a national reckoning on systemic racism — lawmakers are focused on trying to eliminate access to abortion," Jessica Sklarsky, a senior staff attorney at the Center for Reproductive Rights, said in a statement.
Copyright © 2020, ABC Audio. All rights reserved.
iStockBy: ERIN SHUMAKER and IVAN PEREIRA, ABC News
(ORLANDO) -- Florida shattered the nation's record for new daily coronavirus cases this week, logging 15,000 new COVID-19 infections in a single day. The record easily surpassed New York, which on its worst day in April recorded 12,000 new COVID cases.
More than 282,400 people in Florida have been infected with the coronavirus as of July 13 and at least 4,277 people have died, according to the latest figures from the state health department.
While 4,277 deaths may seem low compared to the more than 32,000 deaths in New York State since the beginning of the outbreak, experts say that death is a lagging indicator. Deaths in Florida can, and likely will, rise, experts say.
Another indicator of a worsening outbreak is a rising rate of positive COVID-19 tests. While Florida's positivity rate of testing dipped below 3.6% in early May, it's since soared to 11.2%, according to state health department data, higher than the 10% positivity threshold experts say states should aim to keep well below.
A high positivity rate can be a sign that a state is only testing its sickest patients and failing to cast a net wide enough to accurately capture community transmission, according to Johns Hopkins University, a category Florida is considered to fall into.
By comparison, South Korea, considered a global leader for its COVID-19 response, never had a positivity rate above 1% or 2%. In New Zealand, which has all but eradicated the virus, the nationwide positivity rate averaged 0.3% from January through July.
New York City's positivity rate currently stands at 2%.
When the Centers for Disease Control and Prevention announced their reopening guidelines in April, relatively few states adhered to the agency's suggestions.
"Those are very sound public health principles that were offered to all states," said Dr. Howard Koh, a professor at Harvard T.H. Chan School of public health, who worked in the Department of Health and Human Services during the Obama administration.
Instead, many states pushed to reopen their economies early. In Florida, Gov. Ron DeSantis's stay-at-home order expired May 4 and by early June, the state was reopening bars and entertainment ventures, despite rising cases.
"They reopened too early in hindsight," Koh said, contrasting Florida to states in the Northeast, which had bigger outbreaks early on and tended to follow the CDC's guidelines more closely.
Florida was also behind on recommending that the general public wear masks to stop the spread of coronavirus. While New York Gov. Andrew Cuomo issued an executive order in April, requiring all people to wear face coverings in public, Florida's surgeon general finally made a similar announcement about face coverings on June 22.
"A universal mask policy is long overdue, not just for the state, but for the nation at large," Koh said. "We don’t have a vaccine yet," he added. "Until the FDA approves one, masks are the best vaccine that we have."
In at least one Florida county, local officials are taking matters into their own hands.
Palm Beach County Mayor Dave Kerner told ABC News he is taking the rise in COVID case seriously in his district. Last month, he issued a mandate, directing the public to wear face coverings while outdoors. Later this week, the mayor's office will mail four masks and public health literature to every household in the county.
“For $5 a household we can use our buying power, and in conjunction with the mandate, saturate our community with [information about] the most effective way to combat COVID,” he said. In Kerner's estimation, most local leaders are on the same page when it comes to public health strategies to stem Florida's outbreak, like mask wearing and strict limits on crowds.
Being on the same page, "takes the burden off a particular person or city to be the ‘bad person," he added.
The governor has since rolled back many of Florida's reopening initiatives, including effectively shuttering bars on June 26.
"Governor DeSantis has taken extraordinary steps to combat COVID-19 in Florida," a spokesperson with the governor's office told ABC News in a statement, citing changes to rules at nursing homes, increased testing and the surgeon general's mask recommendation.
"Governor DeSantis’ mission will remain the same, which is to protect the vulnerable, expand testing, encourage the practice of social distancing the use of masks, and support hospitals and health care workers, amongst others."
Florida health care workers and officials, as well as the general public, have had the advantage of learning from hotspots like New York, which battled outbreaks early in the pandemic. Armed with that medical knowledge, they may do better at saving the lives of the sickest COVID-19 patients.
But there's also a confluence of factors working against Florida, according to Koh.
Although the profile of a typical person getting infected with coronavirus now skews younger than it did earlier in pandemic, one in five Floridians is older than 65, meaning a sizable portion of the state's population is at risk for severe COVID-19 complications and death. Like New York City, Florida is diverse. Forty-five percent of residents are Black or Latino, demographics which are show to have been disproportionately likely to become infected with and die from COVID-19.
Another key factor in Florida is insurance coverage. Florida's uninsured rate of 13% outpaced both the national average of 9%, as well as New York's 5% uninsurance rate, according to 2018 Kaiser Family Foundation data.
"If you are an older person in Florida, a person of color and you don’t have insurance, there are a lot of barriers for you to get lifesaving care right now," Koh said.
Notably, Florida is one of 14 states that did not expand Medicaid as part of the Affordable Care Act, a choice that could hurt the state's coronavirus response, according to a paper published in the New England Journal of Medicine last month.
"Covering more people in Medicaid is a rapid way to bring needed resources into the health care system and infuse federal dollars into state economies on the verge of a major downturn," Jonathan Gruber, an economist at Massachusetts Institute of Technology, wrote. As the United States outbreak continues, "both federal and state policymakers are looking to Medicaid as a central tool in their response to this national emergency," Gruber added.
As Florida, as well as Arizona, Texas, California and others, continues to grapple with their respective outbreaks, Koh pointed to the power of basic public health prevention strategies like mask wearing, hand washing and social distancing.
"The only tools we have right now as a society are maximizing the power of prevention in public health," he said. "States that have done that have seen dramatic progress."
But while prevention sounds easy in theory, by now most Americans know that it's more difficult in practice, especially over long periods of time.
"Everyone has to appreciate how fragile the gift of health is," Koh said. "At a time like this, that gift needs to be protected ferociously."
Copyright © 2020, ABC Audio. All rights reserved.
Supersmario/iStockBy KATIE KINDELAN, ABC News
(NEW YORK) -- The U.S. Food and Drug Administration (FDA) has expanded its list of hand sanitizers to avoid because of potential hand dangers.
The agency recently added dozens of products to the list over concerns about methanol contamination.
"That should never be in a hand sanitizer," ABC News chief medical correspondent Dr. Jennifer Ashton said of methanol. "Its absorption can produce toxic, and in some cases, deadly results."
The FDA now lists 59 different brands of hand sanitizer to avoid, many of them under the brand Blumen, some of which was sold at the large retailer BJ's. In some cases, the brand has already been recalled.
The sanitizers listed by the FDA have been tested to contain methanol or have been made in facilities where other products have been contaminated.
Methanol, a colorless liquid, can be absorbed into the body through inhalation, ingestion, skin contact, or eye contact, according to the U.S. Centers for Disease Control and Prevention (CDC).
Initial symptoms of methanol poisoning can include headache, nausea and dizziness in the hours immediately after the exposure. More serious symptoms that can develop include blindness and, in some cases, death, according to Ashton.
Federal prosecutors to announce charged 4 Florida residents who allegedly marketed “Miracle Mineral Solution (MMS),” a toxic bleach, as a #COVID19 cure. In prior warning statements, FDA urged consumers not to purchase or use MMS. https://t.co/Q8wfrjF26K
— U.S. FDA (@US_FDA) July 8, 2020
The FDA recommends people turn to hand washing first and only use hand sanitizers if soap and water are not available.
If hand sanitizers are used, the CDC recommends consumers use an alcohol-based hand sanitizer that contains at least 60% ethanol (also referred to as ethyl alcohol).
Consumers should also be wary of hand sanitizers marked as FDA-approved because the FDA does not approve hand sanitizers, according to the agency.
Copyright © 2020, ABC Audio. All rights reserved.
FilippoBacci/iStockBy DR. JESSICA JOHNSON and DR. JAY BHATT, ABC News
(NEW YORK) -- As the coronavirus pandemic rapidly evolved into a public health crisis of global proportions, doctors and scientists embarked upon a real-time journey to uncover how the virus mercilessly attacks various parts of the body and what to do about it. While medical experts have been troubled by the respiratory virus’ tendency to wreak havoc on the lungs, perhaps more puzzling has been its relationship with the heart.
More than six months into the global pandemic, studies have shown that COVID-19 can not only exacerbate existing heart problems, but could also potentially cause new ones, causing experts to question whether the cardiac impacts of the virus may outlast the infection itself.
While not conclusive, case reports of long-term heart problems following COVID-19 infection are beginning to surface, including one from a New York City critical care physician who had mild symptoms of coronavirus but was later diagnosed with new heart disease.
"I started to feel like my heart was racing and I couldn’t run around like I always do and I had trouble catching my breath,” Dr. Janet Shapiro told NBC New York. It turned out she’d developed cardiomyopathy, a condition in which the heart struggles to pump blood to the rest of the body.
“What is clear is that we are still learning about this disease,” Dr. Shoeb Sitafalwalla, a cardiologist with Advocate Aurora Health in Illinois, told ABC News.
In the six months since the pandemic began, doctors have already learned a great deal about the toll COVID-19 takes on the heart during acute infection, but they still have a lot to learn about it’s long-term impact, Sitafalwalla explained.
Back in February, research from China found people with preexisting heart conditions were more likely to die of the infection, with the Chinese Center for Disease Control reporting a death rate four times the population's average. As the virus spread globally beyond China, this was followed by a smaller Italian study showing hospitalized COVID-19 patients with heart disease had approximately double the risk of death compared to those with previously healthy hearts, as well as markedly elevated risks of blood clots and septic shock.
More recently, a large-scale study out of Brigham and Women’s Hospital published last month corroborated the elevated risk of COVID-19 death internationally, finding in-hospital mortality rates of 10 to 15% depending on the underlying heart condition, approximately double the risk of those without these conditions.
Meanwhile, as data came in from around the world, the CDC offered official guidance that serious heart conditions can increase the risk of severe illness and death from COVID-19.
But what scientists and doctors saw next puzzled them.
In hospitals across the globe, young, healthy patients with no history of heart disease showed signs that COVID-19 had taken a hefty toll on the heart.
Given the recent discussion on safety in sports, some experts now say that athletes who have had COVID-19, particularly if severe, may need follow-up to evaluate their risk for playing sports, as viral inflammation of the heart can lead to sudden cardiac death. Parents and kids alike may need to consider safety guidelines.
By peering into the cells of COVID-19 patients, scientist are finding, according to an article in the Journal of the American Medical Association, that approximately 10-30% of people hospitalized with the virus show molecular evidence of new cardiac injury.
Interestingly, doctors point out that although these molecular signatures often indicate a patient will take a turn for the worse, they don't always spell disaster for the heart.
“So far the amount of cardiac injury has not been tremendous," said Dr. Sean Wu, cardiologist at Stanford Healthcare--meaning most people who develop these laboratory abnormalities do not necessarily end up having heart problems clinically. He contrasted this with other viruses known to infect the heart, like the Coxsackie B3 virus, which tend to cause problems as a result of inflammation in the heart muscle or “myocarditis” for months to years.
The autopsy findings of patients who died from the virus only seemed to deepen the mystery. New York City medical examiners recently reported, according to The Washington Post, that while their findings were consistent with doctors’ reports of SARS-CoV-2 related lung, kidney and liver damage, they surprisingly found little evidence of physical damage to the heart.
Regardless of the cause, recovery from the virus may not mean full recovery for the heart, warns Dr. Raul Mitrani, a University of Miami cardiologist who specializes in electrophysiology. In a new HeartRhythm report, he draws from a review of current literature and personal experience to offer guidance on the possibility of long-term COVID-19 cardiac sequelae including abnormal heart rhythms.
Experts like Mitrani are speculating that long-term heart damage might manifest in unexpected ways, potentially through scar tissue accumulation in the heart, and are highlighting “post-COVID-19 cardiac syndrome” as an important area for future research.
"We have developed a post-COVID Cardiac Clinic to screen patients for residual heart problems," said Mitrani.
But other experts say it's too early to know if long-term heart damage is likely to be a problem. Unlike Mitrani, Wu and his colleagues haven't yet seen anyone with persistent COVID-related heart problems after hospital discharge.
“I think because we’ve only seen COVID within the last few months we don’t have any longer term data in terms of how many people having had myocardial injury will end up requiring continued follow-up for those cardiac manifestations,” explained Wu. “I think we’re just a little early in terms of quite knowing how this will end up.”
Copyright © 2020, ABC Audio. All rights reserved.
Blue Planet Studio/iStockBy LAURA ROMERO, ABC News
(NEW YORK) -- Everything was perfect for Alfredo Chable and his wife, Juanita Marchán. The Mexican couple had been buying baby clothes, toys and preparing their son for the arrival of their second child when Marchán felt body aches and ran a high fever 36 weeks into her pregnancy in mid-June.
Chable rushed his wife to the hospital in Houston and said goodbye to his wife, a day before they were supposed to celebrate their 11-year wedding anniversary. Two days later, after his wife tested positive for the coronavirus, Chable received the worst news of his life: Juanita Marchán had passed away from virus complications.
"I can't believe this happened to my family," said Chable. "My heart is broken."
Chable's son is still in the neonatal intensive care unit after doctors performed an emergency cesarean section on Marchán the day before she died.
Marchán represents a growing number of Latinas who comprise a disproportionate share of coronavirus cases according to the latest pregnancy data released by the Centers for Disease Control and Prevention.
To date, the CDC said it is aware of 11,312 pregnant women who have tested positive for COVID-19. Of that amount, Hispanic and Latino women accounted for more than 4,500 cases, with 3,252 hospitalized and 31 who have died.
Dr. Atul Nakhasi, a primary care physician and policy adviser at the Department of Health Services in Los Angeles, the nation's second-largest health system, said multiple factors can explain the data released by the CDC.
"Pregnant women access health care more regularly, they need to come in for their ultrasounds or prenatal appointments, they need to come in regularly and routinely to check on mom and check on baby," Nakhasi told ABC News. "They're in the health care setting which is arguably one of the most high-risk environments."
According to a morbidity and mortality study mentioned in the CDC report, among reproductive-age women with COVID-19, pregnancy was associated with hospitalization and increased risk for intensive care unit admission, and receipt of mechanical ventilation, but not with death.
"Pregnant women had more severe outcomes than non-pregnant women, they were hospitalized at five times the rate of pregnant women with COVID-19 compared to non-pregnant women with COVID-19 and they were more likely to go into ICU for critical care," said Nakhasi. "But the interesting thing is pregnant women with COVID-19 have lower mortality rates. Are doctors being extra cautious and upgrading them to critical care status and maybe protecting their lungs early by putting in a breathing tube? "
For 20-year old, Jatziry Ramos who tested positive for the coronavirus late into her pregnancy, carrying her baby to term was her priority.
"I was 37 weeks pregnant and I was terrified," said Ramos. "All I wanted was for my baby to be born healthy and at the right time."
Ramos gave birth to her son in late April without any complications. He was tested for COVID-19 soon after being born but the result was negative.
"He's my baby, he's my everything," Ramos told ABC News. "He needed to be OK."
Though much is still unknown about the risks of COVID-19 to newborns, they can be infected with the virus that causes COVID-19 after being in close contact with an infected person, according to the CDC. There may also be an increased risk of adverse pregnancy outcomes, such as preterm birth, among pregnant people with COVID-19.
For Latinos, the new data is a grim reminder of how they shoulder a disproportionate share of coronavirus cases.
Statistics released by the CDC last month showed the percentage of Hispanic/Latino Americans making up coronavirus cases is almost equal to whites -- around 34% -- despite Latinos being a significantly smaller portion of the population.
"People are starting to finally deconstruct the data but for a long time we've known anecdotally, that the Latino community has been disproportionately affected by the coronavirus," said Ana Marie Argilagos, president of Hispanics in Philanthropy, a fundraising and grant-making organization which seeks to strengthen Latino leadership.
"Historically, Latinos have had less access to quality health care and because of our cultural backgrounds, we tend to not let our families out on the streets which means a lot of overcrowding."
"My parents work in restaurants and I think that's how I got infected," said Ramos. "They have to work no matter what the circumstances are."
Argilagos also says that because Latinos typically work essential jobs, they cannot stay at home to telework.
"Only 16% of Latinos can work from home," Argilagos told ABC News. "They work in agriculture, construction, transportation. They are invisible in terms of receiving protections and support but they are the ones keeping the country going."
Dr. Nakhasi says the CDC data is not surprising.
"We've seen this impact all segments of the population within the Latino or the Black community," Nakhasi told ABC News. "Whether you're pregnant, not pregnant, older or younger, coronavirus is disproportionately affecting these communities in every way."
"It is sad and unfortunately, it's not surprising but these results are a call-to-action to be honest," said Nakhasi. "We have two lives at stake -- a mother and a baby. We have to protect the most vulnerable within our communities of color."
Chable's family is asking for donations to help with the unexpected medical bills and funeral expenses.
"I am praying every day," said Chable. "I am praying for God to give me the strength I need to raise my sons without my wife. I don't know why this happened to us but I have faith in God."
Copyright © 2020, ABC Audio. All rights reserved.
Adene Sanchez/iStockBy HALLEY FREGER, ALLISON PECORIN, and MATTHEW MOSK, ABC NEWS
(AUSTIN) -- The senior citizens who populate Texas nursing homes were not jammed into bars or packed onto beaches on Memorial Day, but officials there now fear that coronavirus that began spreading among younger people over the past month is imperiling the lives of the state’s most vulnerable.
It was a grim but predictable development for a state with more nursing homes – 1,218 – than any state in the nation, experts told ABC News. Some said they already suspect a link between the recent spread of the virus and a rise in deaths in the state's nursing homes over the past weeks, and said they fear the worst could be yet to come.
Back in mid-May, nursing homes in the state had reported 561 deaths from COVID-19, according to an ABC News review of state data. By last week, that number had nearly doubled at 1,035 deaths.
“As [the infections] continue to grow in numbers in the community, we would expect it to continue to grow in numbers in nursing facilities,” said Amanda Fredriksen, the Associate State Director for Advocacy for AARP Texas.
While nursing homes nationwide are continuing to experience casualties from the virus, some states that have seen decreases in their case rates are also seeing fewer nursing home deaths. Connecticut, for example, was reporting over 80 probable deaths in congregate care facilities daily in April, when the state was at its peak number of coronavirus cases. Now, Connecticut is reporting fewer than five deaths in these facilities daily as case counts decline.
Derrick L. Neal is the executive director of Williamson County and Cities Health District in Texas, near Austin. That district is home to Trinity Care Center, the facility in Texas that has reported one the highest number of fatalities to the federal government. In mid-June the facility had reported 138 resident deaths.
The region has also seen a rise in cases in the wider community, which he attributes to the state’s late-April opening and Memorial day festivities. Now, Neal said, he’s fearful that what he described as a continued failure by residents to adhere to social distancing guidelines could have a devastating impact on those living in congregate care facilities.
“The overarching concern is really a community, not everyone, but a large segment of society refusing to care for their neighbor by masking up and social distancing,” Neal said. “The same things that kept me up in March keeps me up in July.”
Since the beginning of the pandemic, nursing homes have been at the epicenter of the coronavirus crisis. Nationwide, those who’ve died in nursing homes account for nearly a third of all COVID-19 deaths, according to a recent survey of state-by-state data by ABC News – a figure that advocates believe may actually be undercounted.
In part, that is because national statistics have not fully accounted for some of the fatalities during the early days of the pandemic. Local news outlets in Texas also report that nursing homes in Texas have been among the worst in reporting conditions to federal officials tracking the outbreak.
The official count of the federal agency responsible for regulating nursing homes and tracking coronavirus cases in nursing homes says that 35,517 nursing home residents have died nationwide.
That number has continued to grow despite an evolving toolkit of preventative measures that began in March with the federal guidance to nursing homes to restrict visitors, isolate the sick, and require staff wear protective equipment.
In June, Texas followed the lead of Maryland and other states in forming “strike teams,” which could mount a rapid response when a nursing care facility showed the early signs of an outbreak.
Representatives for the Texas Department of State Health Services did not immediately respond to ABC News' request for comment for this report. The Texas governor has previously stated that protecting seniors in nursing facilities is a priority and earlier this month encouraged nursing homes to apply to receive parts of over $9 million in federal funding being allocated to Texas nursing homes.
"We know that older Texans are more susceptible to COVID-19, and Texas is committed to ensuring that nursing facilities have the tools they need to keep their residents and staff safe,” Abbott said in a press release. “We must continue to protect our most vulnerable populations, mitigate the spread of COVID-19 in Texas, and protect public health.”
But last month, when the state started seeing a rise in infection among young people, advocates for the elderly began to worry that their defenses would not be strong enough to prevent the virus' spread into nursing homes. That, said Patty Ducayet, the State Long-Term Care Ombudsman for the Texas Health and Human Services Department, appears to be happening now.
“We are still seeing new cases identified in both our nursing facilities and assisted living facilities,” Ducayet said.
Neal said he’s also concerned that staff, many of whom are low paid and lack the luxury of social distancing in their own living situations, are proving to be a vulnerability in the chain of transmission.
“It's really extremely difficult to stabilize a group of patients when you have a lower pay individual going in there to support them,” Neal said.
Organizations that advocate on behalf of nursing homes are urging that the rise in cases be met with a surge in testing and personal protective equipment for nursing homes. According to a survey by the Association for Health Care Associations, nursing homes report that they are still struggling to get tests processed in a timely fashion, and many report they do not have adequate access to protective equipment.
Testing is once again becoming a challenge nationwide as some facilities report being overwhelmed by the recent surge in cases. Jo Lynn Garing, a spokesperson for a leading high-volume test manufacturing company Roche Diagnostics, said the company is focusing on vulnerable states like Texas.
Garing said the company not only has been expanding its production capacity but also continues to be “very intentional” on its allocation and distribution of supplies, “prioritizing labs with the broadest geographic reach and highest patient impact.” Garing said the current priority areas are the same areas seeing surges, including Florida, Arizona, Texas and California.
On Friday, Governor Abbott announced a new partnership with Omnicare, a CVS health company, to provide COVID-19 point-of-care testing for assisted living facilities and nursing homes throughout the state. A release states that this partnership will help the state meet its goal of processing up to 100,000 tests in the first month it is operational.
"Our collaboration with public and private entities is crucial to ramping up testing in Texas and mitigating the spread of this virus—especially among our most vulnerable populations," Gov. Abbott said in a statement provided to ABC news after an inquiry for this report.
Aggressive use of preventive measures now could help, advocates say. But while community spread continues, nursing homes remain vulnerable.
“As long as those cases keep rising and as long as they're active in the community where these facilities are, it's going to be a concern for all of these nursing home residents,” Fredriksen said.
Copyright © 2020, ABC Audio. All rights reserved.